Bioethics has dedicated itself to exploring and defending both reasons for and against certain aspects of clinical care, biomedical research and health policy, including what decisions must be made, who should make them, and how they should be made. In pediatrics, it’s widely acknowledged that parents’ reasons may matter pragmatically; attending to parents’ reasons is important if we want to work with families. Yet the conventional view in pediatric ethics is that parents’ reasons are irrelevant to whether a decision is (...) permissible or impermissible according to accepted ethical standards. In this paper, we explore whether parents’ reasons matter ethically and, if so, in what way and for whom. First, we clarify what we mean by ‘reasons.’ Second, we provide an overview of how reasons are typically treated in medical decision-making and pediatric ethics. Third, we analyze a hypothetical pediatric case to illustrate how changing reasons can transform ethical analyses, including by contributing to where and how clinicians and ethicists draw the boundaries intrinsic to common pediatric ethical frameworks. We push back against the conventional view and argue that parents’ reasons matter ethically in several ways. We call for further research on the role of parents’ reasons in clinical ethics deliberation. (shrink)

Ethical decision making for pediatric populations is necessarily contextualized in a network of adult decision-makers, some of whom may be marginalized in complex systems of power, culture and gend...

Amy E. Caruso Brown (2022) considers situations in which a minor child’s parent or legal guardian (the “marginalized decision-maker (MDM)”) defers to another individual (the “primary decision-maker...

Caruso Brown brings forward an argument that clinicians and ethicists have a duty to consider decision-makers marginalized by hierarchical structures. The author presents a pragmatic approac...

Shared decision-making between patients and physicians strives to balance decisional responsibility for clinical decisions. Directed by patients, SDM incorporates patients’ values and prefere...

We endorse Amy Caruso Brown’s position that clinicians and ethicists should consider the voices of people marginalized by hierarchical family or community structures. In this open peer comme...

Perhaps the central focus of American bioethics has been to push against medical paternalism on the grounds that it impedes the autonomy of patients—that is, their ability to make choices of their...

As complicated as decision-making in pediatrics is, we should be grateful that most of the time, it works. The inherently dyadic or triadic nature of interactions between clinicians, pediatric pati...

In “Acquiescence Is Not Agreement: The Problem of Marginalization in Pediatric Decision Making,” Caruso Brown argues that clinicians and ethicists should attend to voices marginalized by hie...